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36905-Z
Town of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 4/16/2012 CERTIFICATE OF OCCUPANCY No: 35544 Date: 4/16/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: PORCH 9580 Route 25, East Marion, Sec/Block/Lot: 31.-10-3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 10/31/2011 pursuant to which Building liermit No. 36905 dated 1/5/2012 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: renovation to an existing covered porch as applied for. The certificate is issued to Hardt Jr, Richard & Hardt, Lorraine (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A~j~I/Signfit~r e 3t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 36905 Permission is hereby granted to: Hardt Jr, Richard & Hardt, Lorraine 72-14 66th Rd Middle Village, NY 11379 Date: 11512012 To; renovation of an existing porch as applied for At premises located at: 9580 Route 25, East Marion SCTM # 473889 Sec/Block/Lot # 31 .-10-3 Pursuant to application dated To expire on 7/5/2013. Fees: 10/31/2011 and approved bythe Building Inspector. CO - ALTERATION TO DWELLING SINGLE FAMILY DWELLING - ADDITION OR ALTERATION Total: $50.00 $320.00 $370.00 Building Inspector Form No. 6 TOWN OF SOUTHOLD. BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCy This application must be filled in by typewriter or ink and submitted to the Building Department with the foJloy~ing: A. For new building or new.use: 1. Final survey of property with aCCUrate'location of all buildings, property lines, streets, and unusual natumt or to~ogmphic fearnms. 2. Final Approval from Health D.~pt. of water supply and sewemgc-<lisposal (8-9 form). 3-. Approval o f ol¢c/aica[ instailation fi'om Board 6 f Fire Underwriters. ' 4. 'aw.om statcmont from pluml~er certifying that tho solder used in system contains less than 2/10 of 1% lead. . 5. Commercial building, industrial building, mtiltiple residences and similar buildings and installations, a certificate of Code Compliai~ce'from architect or engineer responsible for the building= -6. Submit planuing Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 195'0 don-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, s~, building and unusufi. I natural or topographic features. 2. A properly egmpleted application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. C~rtificaie of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.06, ,~- Swimming po01 $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.0(Y. ~. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of. Occupancy - $:25 · 4. Updated Certificate of Occupahcy - $50.00 · 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: Location of Property: .~i~,~ c~'"~ ~ t~ Sbu'Yolk Co.unty Tax Map No 1000, Sectiqn ' ~ '~ Subdivision Permit lqo. H~alth Dept. Approval: Planning Boartl Approval: Date of Permit. /vA, (check one) Hamlet Bio~k / O Filed Map. Applicant:, Undetwrite~ Approval: Request for: Temporary Certificate Final Certificate: Fee Submitled: $ (check one) Applicaul Sig~ure TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 [ 1 ST [ ] C)N 2ND /STRAPPING [ ] FIREPLACE & CHIMNEY ROUGH PLBG. INSULATION FINAL FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (RO~UGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT, 765-1802 INSPECTION ~ ] FOUNDATION 1ST I ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ ]~SU~ATION [ ] FRAMING/STRAPPING ~'~FINAL ~ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ]ELECTRICAL(ROUGH) [ ] REMARKS: /~//~/~.~ ELECTRICAL (FINAL) TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAPPING FIREPLACE & CHIMNEY ROUGH PLBG. INSULATION ~FINAL ~_~ o' [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS:_ ~ (~~ / DATE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net Examioed / Approved )/~ , 20 / d Disapproved a/c Expiration 7/~ , 20 ) ~ JAN 4 20 2 BtDG DEPI. TOWN OF SOL,THO[D Building Inspector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mailto: reO -tT ct ,/c Phone: APPLICATION FOR BUILDING PERMIT Date ]- ~/ ,20 [~,~ INSTRUCTIONS completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~-~(~ gc~ If applicant is a corporation, signature of duly authorized officer (As on the tax roll or latest deed) (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section 5/ Block Subdivision Filed Map No. Lot , ~ Lot State existing use and occupancy of premises and intended use and occupancy of proposed constxuction: a. Existing use and occupancy , b. Intended use and occupancy Nature of work (check which applicable): New Building. Repair ~ Removal Demolition Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars Addition Alteration O~er Work' l~ao2fi tc~tlCbescriptioh) (To be paid on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front q~? t_ ~, Rear 7' Depth Height I{ ~0' 4/_ Number of Stories Dimensions of same structure with alterations or additions: Front C/.0 t_ ~. Rear Depth "]' Height j/t_r_2. 4/_ Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO__ 13. Will lot be re-graded? YES__ NO x/C Will excess fill be removed from premises? YES__ NO 14. Names of Owner of premises ~f-~L Name of Architect (~v'drc'~rx Name of Contractor /'~,. YI~0~t:2 Address ~-. L/I~LIrI~ Phone No. Address ~l{.M~ff 1~{.~ PhoneNo Address ./~'. ~dlLl4~atO Phone No. 15 a. Is this property within 100 feet of a tidai wetland or a fi'eshwater wetland? *YES NO/)~ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO /kc · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) ~ 6C~ °["'/~a3f being duly sworn, deposes and says that (s)he is the applicant (Name of individual s'Igning contlmct) above named, CONNIE D. BUNCH Notary Public, State of New Yonk (S)He is the D~la/¢~/ No. 01Bus185050 Ouaii~i~i ;,, ~,,c. lk County .,... (Contractor, Agent,~orporate Officer, etc.) Commission Expires April 14, 2 of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swo~,to before me this t~ day of ~t&U~v~ 20 /~ Notary Public ~ sig~ay of AlSpllcant TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (651) 765-9502 SoutholdTown.NorthFork.net Exanlined ,20 Approved ,20 Disapproved aJc Expiration ,20 PERMIT NO. BkDIi. 10W~101: $01JIH0tl} BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Single & Separate Storm-Water Assessment Form Contact: (_2. , 7-/'tO~'~<l Cc~&t~' Mailto: /~O/~g) X IT-i/ Phone: d -~ / - q-'3--6 'Z/~ l¢'~ Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ,20 lr a. This applicatiou MUST be completely filled in by typewriter or in iuk and submitted to the Building Inspector with 4 sets of plans, accarate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c, The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildiug Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 montbs from such date. If ilo zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Depamnent fbr the issuance ora Building Permit pursuant to the Building Zone Ordinauce of the Towu of Southold, Sufl'olk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as berein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors oil premises and in building for necessary inspections. Signat~o'f app~t or name, if a corporation) (Mailing address of'applicant) H~' 90 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which propose_dg, vork will be done: "/1'-8--O Hamlet House Number Street County Tax Map No. 1000 Section q Block Lot Subdivision ~ ( Filed Map No. ] 0 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: " a. Existing use and occupancy 0T~,t flOr b. Intended use and occupancy Nature of work (check wMch applicable): Nl~v~Bmldmg , =:. ~, Ad&uon Alteration · ~ ..~ . i , 7~ i , ~'~: - Repair Removal : ~m~ ..'.'.~..?-! _?.g_/~th~ Work_ ~ __ .. ~ ~ ' .. (Descnpt on) 4. Esnmated Cost ~ OOO , j'~: ~ee' ~.-~ ~, ~: ~ j ' , ~ ~o be paid on filing this application) 5. If dwelling number of dwelling units i ~ Num~r~f~ling~mits on each floor { If garage, number of cars ~ 0,: ' '.~, ~ If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front ~5~ < Rear ~'.5-' Depth '-) Height_ .~ ~ Number of Stories ! 9. Size of lot: Front 10. Date of Purchase Dimensions of same structure with alterations or additions: Front Depth -2 r Height. ~ ¢ Dimensions of entire new construction: Front ~ ~ Height ..?' Number of Stories / Rear Z --"- / Rear Number of Stories / Rear -~ -> ~ ~ Depth Depth Name of Former Owner t4/o-~-('? ~7~'-~ '~. "~f'., 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO w'"' 13. Will lot be re-graded? YES NO ~"~Will excess fill be removed from premises? YES NO 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor ~ , '7It o,-/a Address Phone No. q -.~ g *-I 6 I -{- 15 a. Is this property within I00 feet ufa tidal wetland or a fl'eshwater wetland? *YES __NO ~ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, ~o scale, with accUrate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. A~'e there any covenants and restrictions with respect to this property'? * YES · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) SS: COUNTY OF ~;(.~/, (~/~0,_t/[ ~ '°) '--~ O'}r- ('~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signiug contrl~ct) above named, (S)He is the ~_0.5~"'~ O.~C._~-'O0"~--- (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to pedbrm or have performed the said work and to make aud file this applicatioa: that all statements coutained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed there,Mth. Sworn to before me this ~ ¢ ~ day of 0 Q~ 20 [ { VICKITO'TH - ~ua fed in Suffolk ~u~' ; Nota~ Public ~mmissio. ~oires lutv P r~ ~ ~ Signature o~pplicant ·~) Town Of Southold . Erosion, Sedimentation & Storm. Water Run.off ASSESSMENT FOR~" ~CO~O~WO~ - PRO~ CON~U~ON ~~) . ~m ~~ ~e ~6~ ~ P~. 5 6 ~ DEC ~WPpP ~~~~~(1)~ wn~ ~ ~ (15} f~t ~V~ Ri~ to ~ ~c ~ co~ OF.~.~..~.t~ ....... *~. ~, ~ ~5 ................................... S~m }o ~forc mc ~s; ...................... FORM - 06/~ 0 ...... 01T06190~ Quali I in Suffo Commissi Expires HAI DT DENCE FLOOR BOARD5 ?OXCH OLUMND TO REMAIN ?OI~CH FLOOIE ?lJkN SCALE: ¼"= ILO" D(15TING PORCH CEILING, ROOF ¢ 6TP~UCTURE TO REMAIN; TEMPORAP~ILY SUPPORT STEP5 TO PORCH 765-1802 8 AM TO 4 FM FOR Th, FOLLOWING INSPECTIONS 1 FOUNDATION - TWQ REQUIRED REQUIREMENTS OF THE ~,OBES 0r 4P- j £ ~ - ©o 0 >-2° [12 ALL LOCATIONS) PORCH 7, 0 ffRAME PLAN SCALE: ¼"= ILO" (APPROXIMATE) / EXISTING POUNDATION WALL / AND FOOTLNG5 TO P-~MAIN UNEXCAVATED PORCH SECTION h, = I '-O" SCALE: 4